| Objective: The purpose of this study was to investigate the clinical efficacy and early prognostic effects of two different blood purification modes on the treatment of acute paraquat poisoning.Methods: In this study,we used retrospective analysis research method to collect medical records of 98 patients with acute paraquat poisoning in the emergency department of XXX Hospital of Air Force Military Medical University,and divided the patients into three strata according to the different doses of poison via oral administration at the time of admission,namely,less than 5 ml,5-10 ml,and more than 10 ml,and then divided the patients into two groups according to the different modes of blood purification treatment,namely,hemoperfusion(Hemoperfusion(HP)treatment group,Hemoperfusion(HP)combined with Continuous renal replacement-ment therapy(CRRT)treatment group,and the patients’ general data,relevant laboratory tests at admission and 72 hours after treatment were collected respectively.The data obtained were statistically analyzed using SPSS23.0 software to evaluate the prognosis and early efficacy of the two different hemodialysis modes in the treatment of patients with acute paraquat poisoning.Results:1 Analysis of the efficacy and prognosis of the two groups when the dose of poison taken was less than 5 ml1.1 When the dose of poison taken was less than 5 ml,compared before and after treatment in the HP+CRRT group,it was found that plasma paraquat concentration and IL-6 decreased to different degrees,and the difference was statistically significant(P <0.05),ALT,AST,TBi L,DBi L,BUN,SCr and Pa O2 increased to different degrees,and the difference was statistically significant(P < 0.05).When comparing the groups before treatment,plasma paraquat concentration and IL-6 were found to be decreased to different degrees,and the difference was statistically significant(P < 0.05),ALT,AST,TBi L,DBi L,BUN,SCr,APTT were increased to different degrees,and the difference was statistically significant(P < 0.05).1.2 Comparing again the differences of each laboratory test index between the two groups after treatment,it was found that the differences between the two groups in the values of WBC,N,ALT,AST,TBi L,DBi L,BUN,SCr,k+,Na+,Pa02,APTT,TT were not statistically significant(P > 0.05).In contrast,plasma paraquat concentration(0.15±0.20ug/ml)and IL-6 values(21.88±17.37ng/L)in the HP+CRRT group were significantly lower than plasma paraquat concentration(0.39±0.51ug/ml)and IL-6(34.73±24.06ng/L)in the HP group,and the differences were statistically significant(P<0.05).2 Efficacy and prognosis analysis of the two groups when the dose of poison was 5-10ml2.1 When the dose of poison was 5-10 ml,the plasma paraquat concentration,IL-6 and Pa O2 decreased to different degrees before and after treatment in the HP+CRRT group,and the differences were statistically significant(P<0.05),and N,ALT,AST,BUN and SCr increased to different degrees,and the differences were statistically significant(P<0.05).compared with the HP group before and after treatment,the plasma paraquat concentration,IL-6 and Pa O2 decreased to different degrees,and the differences were statistically significant(P < 0.05).Plasma paraquat concentration,IL-6,and Pa O2 all decreased to different degrees,and the differences were statistically significant(P < 0.05),and WBC,ALT,AST,BUN,and SCr all increased to different degrees,and the differences were statistically significant(P < 0.05).2.2 Comparing again the indexes of laboratory tests between the two groups after treatment,it was found that the differences between the two groups in the values of WBC,N,IL-6,AST,TBi L,DBi L,BUN,k+,Na+,APTT,TT were not statistically significant(P > 0.05).And the differences in ALT,SCr,Pa O2,and plasma paraquat concentrations were statistically significant(P < 0.05).the values of ALT in the HP+CRRT group(123.95±32.89 iu/l)were significantly lower than those in the HP group(160.73±38.69iu/l);the values of SCr in the HP+CRRT group(190.57±76.86 umol /l)values in the HP+CRRT group were significantly lower than those in the HP group(262.67±110.38umol/l);Pa O2 values in the HP+CRRT group(88.67±4.47%)values were significantly higher than those in the HP group(82.93±6.53%);plasma paraquat concentration values in the HP+CRRT group(0.60±0.74ug/ml)values were significantly lower than those in the HP group(1.18± 0.65ug/ml).3 Efficacy and prognosis analysis of the two groups when the dose of poison taken was greater than 10 ml3.1 When the dose of poison taken was >10ml,the plasma paraquat concentration and Na+ decreased to different degrees in the HP+CRRT group before and after treatment,and the differences were statistically significant(P<0.05),ALT,AST,TBi L,DBi L,BUN,SCr,Pa O2,TT increased to different degrees,and the differences were statistically significant(P <0.05).When compared before and after treatment in the HP group,AST and Na+decreased to different degrees,and the differences were statistically significant(P < 0.05),and ALT,TBi L,DBi L,BUN,SCr and Pa O2 increased to different degrees,and the differences were statistically significant(P < 0.05).3.2 Comparing again all laboratory examination indexes between the two groups,it was found that the differences between the two groups in the values of plasma paraquat concentration,WBC,N,IL-6,ALT,AST,TBi L,DBi L,BUN,SCr,k+,Na+,Pa02,APTT,TT were not statistically significant(P>0.05).4 Comparison of 28-day morbidity and mortality rates(%)of patients with acute paraquat poisoning4.1 When the dose was <5 ml,the 28-day morbidity and mortality rate in the HP+CRRT group(36.00%)was lower than that in the HP group(44.44%);when the dose was 5-10 ml,the 28-day morbidity and mortality rate in the HP+CRRT group(52.38%)was lower than that in the HP group(66.67%);when the dose was >10 ml,the 28-day morbidity and mortality rate in the HP+CRRT group(80.00%)was lower than that in the The 28-day mortality rate in the HP+CRRT group(80.00%)was lower than that in the HP group(88.89%).The differences between the two groups were not statistically significant in the cross-sectional comparison(P<0.05).In the longitudinal comparison,only the dose of less than 5 ml was statistically significant in the HP+CRRT group compared with the dose of >10 ml,and the difference was statistically significant in the HP group compared with the dose of less than 5 ml compared with the dose of >10 ml(P<0.05).Conclusions:1.when the dose of poison taken was less than 5 ml,the progression of the disease worsened in both groups,but the HP+CRRT mode and HP mode were effective in clearing plasma paraquat concentration and inflammatory mediators,but CRRT was better than HP in clearing plasma paraquat concentration and inflammatory factors and controlling inflammatory response.2.When the dose of toxicity was 5-10 ml,the progression of disease worsened in both groups,but HP+CRRT mode and HP mode were effective in clearing plasma paraquat concentration,inflammatory mediators and delaying pulmonary fibrosis,but CRRT may be superior to HP in clearing paraquat toxin,delaying liver injury,kidney injury and controlling pulmonary fibrosis.3.When the dose of toxin was greater than 10 ml,the condition of patients in both groups was still further aggravated,and blood sodium decreased in both HP+CRRT mode and HP mode,among which plasma paraquat concentration decreased significantly in HP+CRRT mode and AST decreased significantly in HP mode.However,there was no difference in the efficacy of CRRT and HP.4.There was an association between paraquat dose and early morbidity and mortality,and the use of CRRT+HP mode or HP mode were effective in reducing early morbidity and mortality of patients only when and only when the dose taken was <5 ml,but there was no difference between CRRT and HP in improving early morbidity and mortality of patients under each dose stratification. |
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